Thread by @dr_benoy_n_shah

**VALVE CASE OF THE WEEK**

@BrHeartValveSoc

I'm on holiday (staycation 😫) so I'll keep it brief! No poll. Experienced scanners will know this, but could hopefully be of use to physiologists and Fellows in training.

This case focuses on the concept of physiological MR...(1)

Patient having an echo for a different reason (i.e. not murmur) had this AP4Ch view in 2014...

This was reported as "mild MR" and a repeat echo was advised in 2 years...(2)

So the patient returns in 2016 for an echo...

Again reported as "mild MR" and again follow-up advised in 2 years' time...(3)

So, here is 2018...!

Guess what...mild MR, come back in 2 years! (4)

And so here is the repeat from this year, the 4th echocardiogram this patient has had in 6 years...(5)

What is the problem? This is NOT mild MR, it is physiological or trivial MR. The important fact is that it is a normal finding and does not need surveillance echocardiography!

When the normal mitral valve closes, the leaflets do not just meet at the tips...there is an area of...

overlap, often called the rough zone, where AMVL & PMVL meet.

So, by definition, when these leaflets meet, the blood that was in that space gets displaced...back into the LA. So, when MV closes, there is often a very brief flash of colour right at the onset of systole that shows

a tiny amount of MR. The brief duration can be well demonstrated by spectral (CW) Doppler or colour M-mode... this patient's CW Doppler is below.

So this patient had unnecessary scans in 2016, 2018 & 2020.

Teaching point - trivial or physiological MR at onset of systole

is a normal finding, please don't report it as mild MR, as this can lead to unnecessary worry for the patient and resource utilisation in the healthcare service!

New case next week!

@TheBJCA @BJCA_Women_LTFT @global_wic @WessexSpRs @ASE360 @BSEcho @EchoCases @echo_stepbystep

#ACCFIT #cardiotwitter #MedTwitter #EACVI #echofirst